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Imagine, or, How I Learned to Stop Worrying and Love the Bomb.

Trigger Point Dry Needling — develop a way to harvest Liver Yang rising, bring the topic up in a crowd of acupuncturists, and reduce our dependence on fossil fuels. I’ll save my full critique of our current response for another day. Today I will paint a picture of what could have been, and could still be, if we were to respond to this issue with healthy Wood.

Imagine, if the community’s response to the topic of dry needling went like this —

Similar to Mark Seems’ response, described in his 1993 book A New American Acupuncture, we recognized that the independent identification of types of physical dysfunction by different modalities can provide fruitful opportunities for integrated medicine.

We made sure that all acupuncture students and practitioners had the opportunity to develop expertise in the needle techniques, point identification, and point selection that is necessary to effectively release stagnation at A Shi points.

Our discussions with Physical Therapists and other professionals were respectful, making clear that we understood their interest in serving their clients. (Just as ours is when we explore our own scope of practice, right?)

We had, in advance of hearings and public statements, carefully explored the consequences of insisting that this technique be described as acupuncture. Might it be easier for the public to understand differences in techniques and training if PT’s and others were encouraged to use distinct terminology? Could our insistence that it be called acupuncture actually set the stage for the slippery slope that we fear?

We honestly and forthrightly identified the amount and type of training we considered sufficient to use this technique. (For instance, if we practice in a state that allows medical extenders, and if we had a spouse who was also a PT assisting in our office, what would be need to teach them before we felt they could use this technique? How long would it take?)

We were consistent in our arguments — for instance, expressing concern over the pain this technique can cause, while later suggesting that we could accept a situation in which the PT’s used a syringe to stimulate the point is not consistent. Likewise, arguing that we already do this technique undercuts the discomfort argument. Another example — we have often argued that patients should have the right to choose their providers, yet here we have argued that patients must be protected from the risk of a poor choice.

We proactively educated the public about our training and experience. (No need to denigrate the training of others in the process.)

We explored employment opportunities at PT offices — illustrating how the hiring of LAcs would enable the PT to avoid altering their practice flow or having to deal with related insurance and paperwork hassles. This would provide employment opportunities for acupuncturists and give clients convenient access to TPDN and full acupuncture treatments.

All providers of TPDN knew the location of LAcs in the area and referral relationships were encouraged as appropriate.

We offered appropriate training to PT’s, DC’s, and others interested and legally able to use this technique in our jurisdiction, building relationships of mutual respect while addressing our concerns about existing training, and, adding a source of revenue for our schools and teachers.

We educated ourselves about the regulatory process, making sure that every LAc understands that our regulatory boards regulate people (LAcs) not techniques, and not the activities of other professions.

This list could be longer, but I bet you get the point. Without resorting to the old canard about the Chinese character for crisis, I will say that this whole TPDN “situation” had (and in some cases still has) the potential to be a huge opportunity for us. Instead, it continues to suck up a lot of time and energy and burn rather than build bridges. What a shame. We have indeed turned potential opportunity into a dangerous crisis.

7 thoughts on “Imagine, or, How I Learned to Stop Worrying and Love the Bomb.”

There are many sides to all arguements. Yes it can be frustrating when I have people contact me for information regarading acupuncture, only to get back to me and say that they are getting ‘acupuncture’ from their PT instead. But I must consider that as ‘acupuncture’ or at least TPDN moves into the mainstream, it is good for traditional acupuncture too. For every client I lose to a PT, another states a preference for TCM acupuncture. I read this morning that the National Institute for Health and Clinical Excellence in the UK has added a recommendation that acupuncture is prescribed for headaches. NICE guidelines recommending acupuncture is surely one of the best endorsements that we can have in the UK. Incidentally I had TPDN from a physio and it was very effective. Not all PTs are good PT’s, some are very good. Not all TCM acupuncturists are good acupuncturists, and some are very good. I am using a PT right now who has great respect for traditional acupuncture and we are swapping books. Maybe we should learn from each other?

I understand your frustration. It is one of the reasons why it has been unwise to insist that TPDN is acupuncture. (See my post on Shifting Sands for more background). I think the profession here chose to go that route because they THOUGHT it would give them control over the procedure. They have won with that position in some states, but I think, ultimately, if the PT’s and MD’s pushed it in court we would lose. If we had taken the position that the technique is an acupuncture technique, but should be called TPDN to make a distinction from it when used as part of an overall treatment, we could have made it a lot easier for patients to know the difference. And, yes, establishing mutually respectful connections with practitioners of other modalities could be hugely helpful as we strive for greater recognition and opportunity.

I really agree with you. We are not seeing the forest through the trees. On the other hand, I understand the fear acupuncturist have because we are not accepted in the medical community. Some feel as though the PT’s are taking bits and pieces then so might others if we don’t defend ourselves. It is a hard call for and against, either side.

Susan, I understand the fear too. That doesn’t mean we should act upon it. Some of us are well accepted by some of the medical community, and we should take a good look at why there isn’t more acceptance. I think there is a lot we could do to increase understanding — attacking MD’s and PT’s (who generally have good connections and shared business relationships with MD’s) probably doesn’t help. Also, no one is taking anything. We can still release A Shi points — and we borrow from other professions all the time. In some states LAcs can order labs, use homeopathy, and do injection therapy. So, we’ve got some double standards here — do as we say, not as we do. For me, it is an easy call to say let’s stop fighting battles that take a toll and that we are, ultimately, unlikely to win (though we may have some temporary victories) and consider whether there is a more effective way to address our concerns.

I know what you say is true. It is not me that you need to convince but it is those who are fearful. As a group of professionals we are generally not accepted in the way other professionals are and we do not have provider status. That does make a difference. If we were considered providers I don’t think we would be having this conversation. I think some are trying to protect the field of acupuncture from what they believe is infringement upon our profession. I personally think they are missing the whole picture and just looking at the frame. At this point in time I am not sure what our profession needs to do now to improve our standing. I think there is a lot of disagreement among acupuncturist about what we should do next.

One of my hopes for this blog is that it will help those who are afraid reconsider their reflexive positions on these issues. Sadly, we don’t seem to have people in the current leadership of the profession who seem willing or able to look deeper. The situation of practitioners in the US varies a great deal, and in some states LAcs are certainly providers (if you mean able to sign up with insurance companies). (I am also planning to explore whether our insistence at joining a failing system makes any sense at some point.) I know many LAcs who are preferred providers who still have the typical knee jerk response to TPDN, so I don’t believe that is the full explanation. Our profession has, for all sorts of reasons, developed the habit of responding to most external stimuli with fear and aggression. I am doing my best to convince us that there is a better way.

I personally, support your position 100%. Yes, I am referring to the failing system. Whether it is a failing or thriving system does not matter. It is the system our country and the people unit have accepted. We have to deal with that as our reality.